13th August 2024

A 48-year-old male presents to A&E after experiencing 4 severe headaches over the last 5 days

A 48-year-old male presents to A&E after experiencing 4 severe headaches over the last 5 days. He reports the headaches have come on suddenly, reaching their highest intensity within 30 seconds. The pain is predominantly at the back of the head. The headache then improves over the next few hours. He is concerned as these headaches keep reoccurring. The first one came on after he had sexual intercourse with his partner. He has a history of migraine and takes regular propranolol and PRN oral triptans. He is sure that this headache is different from his usual migraine headache.

His neurological examination is normal in A&E. A CT head is performed urgently which is normal. This is followed by a CT angiography of the brain which shows multifocal segmental cerebral artery vasoconstriction.

What is the most likely diagnosis?

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